Post-Hospital Syndrome

28.01.2016
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Imagine this: You are sick. You are the sickest you’ve ever been. You want to die. You almost did die. You want to bury your head in your cozy bed for the next two years. But you’re not in your bed. This bed has plastic for covers and sandpaper for sheets.

You need to throw up every thirty minutes but you have to share a bathroom with someone you don’t know, who is also sick. Your room has four walls but one of them is a curtain, behind which this same someone is talking loudly on the phone. You want to be alone, but you can’t shut the door. You want to sleep, but someone is constantly waking you up.  You want your favorite jammies but someone has taken away all your clothes. You need quiet but something is always beeping. You begin to feel better and want some of your mother’s chicken soup but all they have is cup-o-soup.

It is no secret that being hospitalized sucks. I have been overnight in the hospital as a patient four times, and each time by day 2 I was begging to go home. With each of my three children I called my OB after the first night, wanting to know why I couldn’t just leave. The one other time, when I had preterm contractions and the kept me for observation, when they wouldn’t even let me out of bed, was far worse because I did not even have the distraction of a newborn. My butt was numb from the mattress, the coffee was undrinkable, there was no DVR or On-Demand, and I was really hungry because someone forgot to tell me that if I wanted food (hospital food, with which I am all too familiar) I had to call and order it. My second child was in the NICU, and once someone from the postpartum floor actually came and got me from the bedside of my child to take my vital signs.

Historically, hospitals were generally, and justifiably, feared. The earliest ones were really no more than almshouses or insane asylums.  Infection was rampant and conditions were horrible. Dr. James Jackson and Dr. John C. Warren, upon deciding that Harvard Medical School needed an adequate place to teach back in 1918, had to go out and explain why “respectable and worthy persons” should require a hospital.  These persons included widows, good women whose husbands had deserted them, families in which accidents had used up savings, and servants. Wealthy people stayed home and doctors came to them.

Of course, during this time, around 1820, doctors couldn’t do much for people anyway. In fact, doctors in most parts of the country readily acknowledged that people who got better did so because they had rest, quiet, good food, and a clean environment.  In a post I wrote about a year ago I quoted Oliver Wendell Holmes: “What is the honest truth about the medical art? By far the largest number of diseases which physicians are called to treat will get well at any rate, even in spite of reasonably bad treatment. Of the other fraction, a certain number will inevitably die,, whatever is done; there remains a small margin of cases where the life of the patient depends on the skill of the physician. Drugs now and then save life; they often shorten disease and remove symptoms; but they are second in importance to food, air, temperature, and other hygienic influences.”

History repeats. Dr. Harlan Krumholz, a professor of medicine and public health at Yale School of Medicine, described a syndrome that emerges in the days and weeks after a hospital stay: “Physiologic systems are impaired, reserves are depleted, and the body cannot effectively avoid or mitigate health threats.” He called this period of vulnerability “post-hospital syndrome.” What does Dr. Krumholz recommend? Better food, quieter wards, preserving patient dignity, more sleep, more physical activity. These ideas are not new.  They are, arguably, the earliest therapeutic tools of medicine. Just because we have antibiotics and angioplasty does not mean we can’t continue to provide these simple remedies. In the meantime, do everything you can not to get admitted to the hospital. It’s bad for your health.

Image copyright: Valerie Everett, flickr CC-BY SA

Article last time updated on 29.01.2016.

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